Provider Demographics
NPI:1114627742
Name:OGWUDILE, CHUKWUEMEKA GEORGE
Entity Type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:GEORGE
Last Name:OGWUDILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2049
Mailing Address - Country:US
Mailing Address - Phone:972-207-0231
Mailing Address - Fax:
Practice Address - Street 1:7205 PETERSBURG DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2049
Practice Address - Country:US
Practice Address - Phone:972-207-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX867361163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114627742Medicaid